Since the times of the “Good Samaritan”, and many centuries before him, the support for travellers in need has been the work of a minority of charitable and disinterested people, that can act anonymously, but rarely in an organised manner. Nowadays those who suffer on the street can benefit from a public service by calling 999 (118 in Italy), and from an efficient network of local health authorities (LHAs) for emergency interventions. What happens then? What happens to those dealing with poverty, family and social vulnerability factors, mental health issues, and alcohol or substance dependency? What happens to those who are homeless and those who cannot afford to pay for simple things like going to the dentist?
Street medicine: a multicoloured world of support services provided by medical volunteers who understand the needs of their area. Who are they?
The organisation of the support given to the vulnerable groups in the stations of the big cities and the neighbourhoods affected by poverty is managed by voluntary services that are not organised consistently. Street medicine was developed among these initiatives. It is a multicoloured world of support services provided by medical volunteers, almost always retired physicians, who understand the needs of their area and cannot stand to just ignore its issues. Who are they? It is difficult to establish how many volunteers there are and what operational standards they follow. Internationally, there are different intervention models and services that provide healthcare support for the homeless. Effective interventions for cases of substance abuse include the relevant delivery of oral methadone programs, anti-hepatitis A and B injections as well as tetanus jabs, advice on safer methods of injection and access to needle exchange services for drug addicts. Emerging data demonstrates the efficacy of supervised injection sites that provide free syringes, meant for the homeless who inject heroin and for the distribution of naloxone to take home, with the aim to reduce the number of deaths by overdose. Some medical volunteers work with Alcoholics Anonymous, others provide home support services for chronic and dying patients, and some even offer their dentistry expertise to those who cannot afford a dentist. There are also street paediatricians who are dedicated to the support of struggling minors. There is evidence to show that awareness raising programs meant for people suffering with mental or physical health issues, support programs for those motivated to face their alcohol addiction, and informal programs that promote sexual health, can create long-term benefits for the health of the service users.
However, there is poor data to demonstrate that the various support services focusing on healthcare, homelessness, assistance to access public healthcare etc., are effective. There are almost no research studies on the outcomes of voluntary work that, despite coming from the heart, is incapable of developing comparable evidence-based operational protocols. The literature shows that the coordination between services that support homeless individuals suffering with mental health and substance abuse issues results in a marked health/wellbeing improvement and a better access to public healthcare. Evidence shows that street medicine, thanks to the mobility and flexibility of its staff, is able to anticipate the services, that either the LHAs develop later or that become complementary to existing but poor support programs, which lack resources or that the LHAs are slow to restructure. Generally, it is necessary to get an overview of the situation, starting with Padua, the 2020 European capital of voluntary work. It is important to know what common interventions are made by street healthcare workers to gauge what might work best or not.
However, medical volunteers spend most of their time on the field, so asking them to make a further effort and coordinate with colleagues operating in other areas, in order to measure the efficacy of the various services, can be challenging. Therefore, we have to rely on researchers and count on philanthropists to fund research studies on this minority of medical volunteers and the efficacy of their interventions. Will this happen sooner or later? Let’s hope so!
- Fitzpatrick-Lewis D, Ganann R, Krishnaratne S, et al. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review. BMC Public Health 2011;11:638.
- Hwang SW, Burns T. Health interventions for people who are homeless. Lancet 2014;25;384:1541-7.